The Skin and Systemic Disease

Question 1

What systemic condition would you see Necrobiosis lipodica in?

Answer 1

Diabetes

Question 2

Appearance of Necrobiosis lipodica

Answer 2

Circumscribed, multicoloured, waxy, atrophic plaques

Question 3

How many lesions tend to be present in Necrobiosis lipodica

Answer 3

1-3

Question 4

What might there be a history of with necrobiosis lipodica

Answer 4

Trauma

Question 5

Where on the body does necrobiosis lipodica tend to be found?

Answer 5

Bony areas; espec shins/dorsum of foot

Question 6

Who tends to get necrobiosis lipodica?

Answer 6

Young adults (F)

Question 7

4 other dermatlogical conditions associated with DM

Answer 7

Candidal paronychia
Furunculosis
Balanitis
Eruptive xanthomata

Question 8

Appearance of dermatitis herpetiformis

Answer 8

Chronic, recurrent, pruritic eruption on extensors extremities + trunk
Excoriated vesicles

Question 9

If you have GI Sx with dermatitis herpetiformis, what disease might you associate it with?

Answer 9

Coeliac disease

Question 10

Treatment dermatitis herpetiformis

Answer 10

Dapsone

Question 11

Metabolic/endocrine DDx for generalised pruritis

Answer 11

Hyperthyroidism
Hypothyroidism
Chronic renal failure
Carcinoid

Question 12

Malignant DDx for generalised pruritis

Answer 12

Lymphoma
Leukaemia
Myeloma
Solid cancer (rare)

Question 13

Drugs that can caused generalised pruritis (4)

Answer 13

Aspirin
Alcohol
Morphine
Codeine

Question 14

Haematological DDx for generalised pruritis (2)

Answer 14

IDA

Polycythaemia rubra vera

Question 15

Hepatic DDx generalised pruritis

Answer 15

Obstructive biliary disease

Cholestasis of pregnancy

Question 16

What is Xerosis?

Answer 16

Dry skin

Question 17

Tests for widespread pruritis

Answer 17

FBC (anaemia) 
U+E (uraemic syndrome) 
LFT (obstructive jaundice) 
Ferritin - IDA 
ESR - Non-specific marker lymphoma 
TFT - hyper/hypothyroidism

Question 18

Where does Acanthosis nigricans tend to affect?

Answer 18

Axilla, groin, neck

Question 19

Description of acanthosis nigricans

Answer 19

Velvety thickening hyperpigmentation, papillomatous skin

Question 20

If benign, what conditions is acanthosis nigricans associated with?

Answer 20

Insulin Resistance + metabolic syndrome hence ACROMEGALY

Question 21

If malignant, what cancer may acanthosis nigricans precede?

Answer 21

Gastric cancer

Question 22

Which benign conditions is pyoderma gangrenosum associated with

Answer 22

UC, Chrons, Inflammatory arthritis, diverticulitis, chronic active hepatitis and Behcet’s

Question 23

If What % of cases is pyoderma gangrenosum associated with malignancy?

Answer 23

> 10%

Question 24

Which malignancies is pyoderma gangrenosum associated with?

Answer 24

Leukaemia, paraproteinemia, myeloma

Question 25

Common sites pyoderma gangrenosum

Answer 25

Legs/CALF Buttocks Abdomen Face

Question 26

How does pyoderma gangrenosum start?

Answer 26

A tender nodule that ulcerates

Question 27

Does enlargement of pyoderma gangrenosum happen slowly or rapidly?

Answer 27

Rapidly

Question 28

Treatment pyoderma gangrenosum

Answer 28

Ciclopsorin

Question 29

Appearance of acquired ichthyosis

Answer 29

Dry skin with 'fish scale'

Question 30

What medication can acquired ichthyosis be associated with?

Answer 30

Allopurinol

Question 31

What malignant disease is acquired ichthyosis assoicated with?

Answer 31

Hodgkins

Question 32

Modal onset dermatomyositis associated with?

Answer 32

50-70y/o

Question 33

Causes of dermatomyositis?

Answer 33

Genetics Autoimmune Drugs

Question 34

Which cancers has dermatomyositis been linked to increased likelihood of developing? (6)

Answer 34

``` Cervix Lungs Pancreas Breast Ovaries GIT ```

Question 35

Appearance of dermatomyositis at sun exposed areas?

Answer 35

Reddish/blue-purple patches

Question 36

Appearance of dermatomyositis on cheeks, nose, soulders, upper chest, elbows

Answer 36

Violaceous rash

Question 37

Appearance of dermatomyositis on eyelids

Answer 37

Helitrope (purple) rash

Question 38

Appearance of dermatomyositis on bony prominences (esp knuckles)

Answer 38

Gottron (purple) papules

Question 39

Tx regime for dermatomyositis?

Answer 39

Most will req Tx throughout their lifetime

Question 40

What is erythema noduosum

Answer 40

Immunological/inflammatory reaction pattern of SCT fat

Question 41

Appearance of erythema nodosum

Answer 41

Tender, erythematous, bruise like nodules on lower leg extensors

Question 42

Associated Sx erythema nodosum

Answer 42

Fever Malaise Arthralgia

Question 43

Who gets erythema nodosum

Answer 43

15-30y/o | F:M 3:1

Question 44

Underlying triggers erythma nodosum

Answer 44

Infection - strep, 1'TBB Dx - sulphonamides, PO contraceptives Systemic disease - sarcoid, Behcet's, IBD/UC Idiopathic

Question 45

What is erythema multiforme

Answer 45

Reaction pattern to blood vessels

Question 46

Appearance erythema multiforme

Answer 46

Red target lesions | Sometimes macular, often elevated w/ vesicle/bulla centrally

Question 47

Where does erythema multiforme affect ?

Answer 47

Extensor skin

Question 48

Associated Sx erythema multiforme

Answer 48

Pruritis | May be Fever, weakness, malaise

Question 49

How long will erythema multiforme take to settle?

Answer 49

A few weeks

Question 50

What is an intrinsic action of a drug on skin?

Answer 50

Predictable and dose related

Question 51

What is an idiosyncratic drug interaction on skin?

Answer 51

Fixed drug eruption

Question 52

Examples of non-specific drug eruptions

Answer 52

Urticaria + angiodema Vasculitis Erythema multiforme

Question 53

What is the most serious form of a non-specific drug eruption?

Answer 53

TEN

Question 54

Drugs that cause rashes (8)

Answer 54

``` Penicilins/sulphonamides Anticonvulsants NSAIDs Thiazide diuretics Allopurinol Gold + penicillamine ```

Question 55

How long after taking the drug do these rashes tend to occur?

Answer 55

8-21days after

Question 56

When does toxic erythema occur?

Answer 56

7-10 days after intro of drug

Question 57

Sx toxic erythema?

Answer 57

Fever Malaise Pruritis

Question 58

What are the 3 forms of toxic erythema?

Answer 58

Morbiliform Scantiform Confluent

Question 59

Appearance toxic erythema morbiliform

Answer 59

Symmetrical erythematous macules and papules

Question 60

Appearance of scantiform toxic erythema

Answer 60

Tiny red papules

Question 61

Appearance toxic erythema confluent

Answer 61

Large erythematous patches/urticated plaques

Question 62

What can toxic erythema progress into?

Answer 62

TEN | Erythroderma

Question 63

Tx toxic erythema

Answer 63

Stop drug

Question 64

What type of HS reaction is SJS?

Answer 64

IV

Question 65

Where does SJS affect?

Answer 65

Skin and mucous membranes

Question 66

How is SJS classified?

Answer 66

According to its body SA

Question 67

Def of SJS

Answer 67

<10% BSA

Question 68

Def overlapping SJS/TEN

Answer 68

10-30% BSA

Question 69

Def TEN

Answer 69

>30% BSA

Question 70

Prodrome of SJS

Answer 70

Fever + resp Sx

Question 71

PS SJS

Answer 71

``` Red macules Central blister formation Epidermal necrosis Extensive oral involvement Involves 2 mucosa sites Severe eye involvement ```

Question 72

Causes SJ S

Answer 72

Mycoplasma, HSV Dx - NSAIDs, sulphonamides, penicillin's, anticonvulsants, allopurinol Idiopathic

Question 73

Mortality TEN

Answer 73

Up to 90%

Question 74

When does TEN present?

Answer 74

7-21 days after initiation of drug eruptions

Question 75

Appearance TEN

Answer 75

Tenderness + erythema, mucosal involvement. Erythematous macular rash with necrosis

Question 76

Mx TEN

Answer 76

``` Stop Dx Supportive care @burns/ITU Fl Temp control Sterile Wound care ```